Sunday, June 17, 2012

Overused Tests

The American College of Physicians (ACP) is committed to promote high-value, cost-conscious medical care.  They make the point that some treatments are expensive but offer great value, while others may be considered inexpensive and offer little value.  Price (cost) does not equal value. (for more on this read my post on price and quality)

One area where overuse is common is in testing or screening tests.  ACP published a consensus that named 37 commonly overused diagnostic procedures and treatments.   You may be surprised about what they are and here are a few:
  • Annual lipid screening for patients not receiving lipid-lowing drugs or diet therapy
  • Screening low risk people for Hepatitis B  (If you don't have unsafe sex or use IV drugs you are not at risk)
  • Screening for colorectal cancer in adults older than 75 or with a life expectancy of less than 10 years (Yes, lots of doctors do colonoscopies on demented folks in a nursing home or 85 year olds)
  • Ordering chest Xrays for hospital patients who are being discharged home and making a good recovery. (These radiographs give no information at all)
  • Ordering annual electrocardiograms or other cardiac screening for asymptomatic low risk patients.
  • Doing pap tests on patients younger than 21 years or in women who have had a hysterectomy for benign disease.
  • Ordering antibiotics for moderate sinusitis unless symptoms last for more than 7 days. (Stuffy, runny nose is not a symptom to be treated)
The United States has run amok with tests and treatments that drive up costs and offer no value to patients.  I saw an ad on TV tonight for a new drug (that I could not pronounce) for rheumatoid arthritis.  These "disease modulator" drugs have extremely high complication rates and can cost over $2500/month.  The ad encouraged the patient to ask for the medication and promised to pay the co-pay for the patient or to refund the copay if it didn't work.  I did some quick math in my head.  If the copay is $40/month the Company is certainly crafting a good deal for itself.  Insurance companies, Medical and Medicare Part D would pay tens of thousands of dollars for each patient.

And what is with prime-time ads for a disease that only affects about 1 million people?  We are one of the only countries that allows these direct-to-consumer pharmaceutical ads on TV and in magazines.  Other countries have found that this type of advertising brings no value to patients or to society.

  (People with RA:  No need to write me.  I am not against treatment for this terrible disease and it may be that these overpriced medications actually do bring great value.  I just want to make sure the right drugs are going to the right patients)

If we are to dig ourselves out of this medical affordability hole we need a change in the culture of medicine.  We are over tested and over-treated  but don't have the health outcomes to show for it.


Solitary Diner said...

I agree completely, but would add that a major risk factor for hepatitis B is coming from an endemic area such as Africa or Asia.

Anonymous said...

Well I had to say something even though you said us RAers don't need to. I take the biologic Enbrel- I've just passed the one year mark with it after a year on Humira. For some of us these drugs are far more than just good value....they work miracles. For me, since the drug keeps my disease activity between very low and near remission it is quite literally priceless to me- for without it I would live in a world of excruciating and constant pain as my RA went from diagnosed to severe and out of control in less than 3 months. I never thought I'd walk again, let alone drive an eighteen wheeler which is where I'm typing this message from.

Toni Brayer, MD said...

Anon: I am glad for you and thanks for writing. Is an 18 wheeler a semi truck? Now that is a success!